Positive blood cultures in a University Hospital in The Netherlands

Summary During a period of six years, i. e. 1972 to 1977, an analysis was made of bacteriologic, demographic and a restricted number of clinical data related to true bacteremias occurring in a 900 bed University Hospital for adult patients in The Netherlands. Blood cultures were performed in 11% of the patients admitted. The mean number of blood cultures taken per patient amounted to just over four. The incidence of bacteremia and of bacteremic episodes was 1.32% and 1.98% respectively. The age distribution for the occurrence and fatality of bacteremia showed a peak in the seventh age decade. The age-specific attack rates and fatality rates increased sharply from the fifth decade onwards. The ratio of the mean age-specific attack rates in male and female patients was 1.23. This difference was statistically significant. The ratio of bacteremias occurring in surgical and non-surgical services was 2:1. Of the organisms responsible for 90% of the bacteremias, 36% belonged to gram-positive species and 54% to gram-negative species. The fatality rate of all patients suffering from bacteremia was 23%, and this rate increased with the severity of the underlying disease. The fatality rate was significantly lower than 23% in patients with bacteremia caused byStaphylococcus epidermidis (3%) andEscherichia coli (18%), but significantly higher when caused byKlebsiella sp. (32%),Pseudomonas sp. (42%) and mixed species (40%). The ratio between hospital-acquired and community-acquired bacteremias was 3:1. The ratio of fatalities between these two categories of patients was 6.7:1. The difference between these two ratios was highly significant. In 8.7% of normotensive patients, the temperature on the first day of bacteremia did not exceed 38°C. 1.6% of these patients were treated with corticosteroids. The urinary tract, the peritoneum, the lower respiratory tract and the intravenous catheter together constituted more than half (55%) of the portals of entry of the bacteremic episodes. The fatality rate among patients was significantly lower than 23% if the portal of entry was the urinary tract or an intravenous catheter; the fatality rate was significantly higher if the portal of entry was the peritoneum or the lower respiratory tract.

---

Positive Blutkulturen in einer niederländischen Universtitätsklinik

Zusammenfassung Die zwischen 1972 und 1977 an einer 900-Betten-Universitätsklinik für Erwachsene aufgetretenen Bakteriämien wurden an Hand von bakteriologischen, demographischen und einer begrenzten Zahl von klinischen Daten mit Bezug zu echter Bakteriämie analysiert. Von 11% aller in dieser Zeit aufgenommenen Patienten wurden Blutkulturen angelegt, und zwar im Durchschnitt etwas über vier pro Patient. Bakteriämien wurden bei 1,32% aller Patienten und bakteriämische Episoden bei 1,98% festgestellt. Inzidenz und Letalität der Bakteriämien hatten ihren Altersgipfel in der siebten Lebensdekade. Das altersspezifische Vorkommen der Bakteriämien und ihre Letalität nahm vom fünften Lebensjahrzehnt an steil zu. Für die gemittelte altersspezifische Bakteriämieninzidenz bei männlichen und weiblichen Patienten errechnete sich ein Relationsfaktor von 1,23; der Unterschied war statistisch signifikant. Die Relation von Bakteriämien in chirurgischen und nicht-chirurgischen Abteilungen betrug 2:1, sie variierte über die Jahre nicht wesentlich. Von 90% der verantwortlichen pathogenen Erreger waren 36% grampositiv und 64% gramnegativ. Insgesamt betrug die Letalität der Bakteriämien 23%, sie stieg mit dem Schweregrad der Grunderkrankung an. Bei Bakteriämien durchStaphylococcus epidermidis betrug die Letalität 3%, beiEscherichia coli 18% und lag somit signifikant unter der allgemeien Letalität von 23%; Bakteriämien durchKlebsiella sp. lagen mit 32%, durchPseudomonas sp. mit 42% und durch Mischflora mit 40% signifikant über der mittleren Letalität. Ein hochsignifikanter Unterschied bestand in der Anzahl der Hospitalinfektionen und der außerhalb des Krankenhauses erworbenen Infektionen; die Inzidenzen verhielten sich wie 3:1, die Letalitäten wie 6,7:1. Hospitalinfektionen endeten signifikant häufiger letal. Der Temperaturanstieg lag bei 8,7% der normotensiven Patienten am ersten Tag der Bakteriämie nicht über 38° C. 1.6% dieser Patienten wurden mit Kortikosteroiden behandelt. Bei mehr als der Hälfte der Fälle (55%) waren Harnwege, Peritoneum, untere Atemwege und intravenöse Katheter Eintrittspforte für die Bakteriämie. Bakteriämien, die von Harnwegen und von intravenösen Kathetern ausgingen, hatten eine Letalität, die signifikant unter 23% lag, bei primärer Infektion des Peritoneum oder der unteren Atemwege lag die Letalität signifikant darüber.

     

The National Alpha-1 Antitrypsin Deficiency Registry in Poland

Abstract

The alpha-1 antitrypsin deficiency (AATD) targeted screening program, together with the National Registry, were established in Poland in 2010 soon after the AATD diagnostics became available. Between 2010 and 2014 a total of 2525 samples were collected from respiratory patients countrywide; 55 patients with severe AAT deficiency or rare mutations were identified and registered, including 36 PiZZ subjects (65%). The majority of AATD patients were diagnosed with COPD (40%) or emphysema (7%), but also with bronchial asthma (16%) and bronchiectasis (13%). Therefore, the registry has proved instrumental in setting-up the AATD-dedicated network of respiratory medical centres in Poland. Since augmentation therapy is not reimbursed in our country, the smoking cessation guidance, optimal pharmacotherapy of respiratory symptoms as well the early detection, and effective treatment of exacerbations is absolutely essential.     

Comparison of Approaches to National Automation: Iran and The Netherlands

Abstract. Two styles of approach to national automation are discussed. Iran represents the approach labeled 'centralistic' and the Netherlands represents the 'federalistic' approach. There are obviously numerous compromises between these two extremes. None is necessarily inherently superior to any other; which one is adopted will generally depend upon local circumstances- funding patterns, national attitudes rooted in history, geographic factors and the development history of the blood-banking services.     

Cirrhosis as a risk factor for sepsis and death: analysis of the National Hospital Discharge Survey

STUDY OBJECTIVES: The unfavorable influence of cirrhosis on survival in the critically ill has been supported by several single-center reports. Variations in case mix, the technological capabilities of individual facilities, and differences in organizational staffing and structure could limit the extrapolation and generalization of these data to other institutions. To assess the impact of a diagnosis of cirrhosis on outcomes of sepsis, sepsis-related mortality, and respiratory failure in hospitalized patients, we analyzed data from the National Hospital Discharge Survey (NHDS) from 1995 to 1999 to determine its national consequence. DESIGN: Secondary analysis of an existing national database. PATIENTS OR PARTICIPANTS: Based on NHDS estimates, 175 million hospital discharges occurred during the 5-year period of study. One percent (1.7 million) of these hospitalizations involved a diagnosis of cirrhosis. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: After adjustments for age, race, and gender, cirrhotic individuals are significantly more likely to die while hospitalized (adjusted risk ratio [RR], 2.7; 95% confidence interval [CI], 2.3 to 3.1), to have hospitalizations associated with sepsis (adjusted RR, 2.6; 95% CI, 1.9 to 3.3), and to die from sepsis (adjusted RR, 2.0; 95% CI, 1.3 to 2.6). Additionally, cirrhosis is associated with an increased RR for acute respiratory failure (adjusted RR, 1.4; 95% CI, 1.1 to 1.8) and death from acute respiratory failure (adjusted RR, 2.6; 95% CI, 1.5 to 3.6). CONCLUSIONS: In this national database of hospital discharge information, a diagnosis of cirrhosis is strongly associated with an increased risk of sepsis, acute respiratory failure, sepsis-related mortality, and acute respiratory failure-related mortality.     

Validation of ulcerative colitis and Crohn’s disease and their phenotypes in the Danish National Patient Registry using a population-based cohort

Abstract

Introduction

The Danish National Patient Registry (DNPR) has been the source of several epidemiological studies of inflammatory bowel disease (IBD). However, the validation dates back to 1996 and lacks outpatient records and disease classification. The aim of this study was to update the validation and assess the validity and reliability of using the registry in disease classification.     

Decreasing one-year mortality and hospitalization rates for heart failure in Sweden; Data from the Swedish Hospital Discharge Registry 1988 to 2000.

AIMS: To investigate if improved treatment of coronary heart disease and hypertension, the major causes of chronic heart failure (CHF), in the last 20 years has had an impact on the incidence of CHF and survival. METHODS: National Swedish registers on hospital discharges and cause-specific deaths were used to calculate age- and sex-specific trends and sex ratios for heart failure admissions and deaths. The study included all men and women 45 to 84 years old hospitalized for the first time for heart failure in 19 Swedish counties between 1988 and 2000, a mean annual population 2.9 million. A total of 156?919 hospital discharges were included. RESULT: In 1988, a total of 267 men and 205 women per 100?000 inhabitants (age adjusted) were discharged for the first time with a principal diagnosis of heart failure. After 1993 a yearly decrease was observed, with 237 men and 171 women per 100?000 inhabitants discharged during 2000. The 30-day mortality decreased significantly. The decrease in 1-year mortality was more pronounced in the younger age groups, with a total reduction in mortality of 69% among men and 80% among women aged 45-54 years. The annual decrease was 9% among men and 10% among women aged 45-54 years (95% CI -7% to -12% and -6% to -14% respectively) and 4% among men and 5% among women (95% CI -4% to -5% for both) aged 75-84 years. CONCLUSION: The decrease in incidence and improved prognosis after a first hospitalization for heart failure coincides with the establishment of ACE-inhibitor therapy, the introduction of beta-blockers for treatment of heart failure, home-care programmes for heart failure, and more effective treatment and prevention of underlying diseases. Notwithstanding, despite considerable improvement, 1-year mortality after a first hospitalization for heart failure is still high.     

Design and development of a web-based Saudi National Diabetes Registry

Background

Given that diabetes is an extremely common disorder in Saudi Arabia, the National Diabetes Registry was designed by King Saud University Hospital Diabetes Center in collaboration with King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia, in the year 2001. The aim of the registry is to identify risk factors related to diabetes and to provide statistics to public health programs and health care professionals for use in planning and evaluation. The registry was designed to provide information on the extent and nature of specific types of diabetes, diabetes complications, and treatment of diabetes in the Kingdom.The registry has been available since 2001, with major collaborations from 26 hospitals as part of Phase I in which 100,000 patient data is to be collected on a regional level from Ar-Riyadh before extending the program to other regions of Saudi Arabia.

Methods

The web application was designed using relational database techniques along with on-line help topics to assist users to get acquainted with application functionalities. All Internet forms were designed with validation checks and appropriate messages to ensure quality of data.The security measures established within the application ensure that only authorized users can gain access to the functionalities of the registry at allowed times. Administrative features were designed to manage the registry-related operations easily.

Results

The diabetes registry has been in operation for almost 10 years, and around 67,000 patients have been registered to date. The Web-application offers an anytime-anywhere access to the registry’s data, removing geographical boundaries and allowing the national registry to provide real-time data entry, updates, reporting, and mapping functionalities more easily.

Conclusion

Merging related information in the form of databases can provide improved health care operations through instant access to data, ease of managing complex data structures, and creation of reports to be used by health care planners and hospital administrators.     

Pending Studies at Hospital Discharge: A Pre-post Analysis of an Electronic Medical Record Tool to Improve Communication at Hospital Discharge

Background

Achieving safe transitions of care at hospital discharge requires accurate and timely communication. Both the presence of and follow-up plan for diagnostic studies that are pending at hospital discharge are expected to be accurately conveyed during these transitions, but this remains a challenge.

Objective

To determine the prevalence, characteristics, and communication of studies pending at hospital discharge before and after the implementation of an electronic medical record (EMR) tool that automatically generates a list of pending studies.

Design

Pre-post analysis.

Patients

260 consecutive patients discharged from inpatient general medicine services from July to August 2013.

Intervention

Development of an EMR-based tool that automatically generates a list of studies pending at discharge.

Main Measures

The main outcomes were prevalence and characteristics of pending studies and communication of studies pending at hospital discharge. We also surveyed internal medicine house staff on their attitudes about communication of pending studies.

Key Results

Pre-intervention, 70 % of patients had at least one pending study at discharge, but only 18 % of these were communicated in the discharge summary. Most studies were microbiology cultures (68 %), laboratory studies (16 %), or microbiology serologies (10 %). The majority of study results were ultimately normal (83 %), but 9 % were newly abnormal. Post-intervention, communication of studies pending increased to 43 % (p < 0.001).

Conclusions

Most patients are discharged from the hospital with pending studies, but in usual practice, the presence of these studies has rarely been communicated to outpatient providers in the discharge summary. Communication significantly increased with the implementation of an EMR-based tool that automatically generated a list of pending studies from the EMR and allowed users to import this list into the discharge summary. This is the first study to our knowledge to introduce an automated EMR-based tool to communicate pending studies.KEY WORDS: Applied informatics, Care transitions, Electronic health records, Continuity of care, Health information technology, Hospital medicine, Medical informatics, Patient safety, Quality improvement, Communication     

Omission of Dysphagia Therapies in Hospital Discharge Communications

Despite the wide implementation of dysphagia therapies, it is unclear whether these therapies are successfully communicated beyond the inpatient setting. The aim of this study was to examine the rate of dysphagia recommendation omissions in hospital discharge summaries for high-risk subacute care (i.e., skilled nursing facility, rehabilitation, long-term care) populations. We performed a retrospective cohort study that included all stroke and hip fracture patients billed for inpatient dysphagia evaluations by speech-language pathologists (SLPs) and discharged to subacute care from 2003 through 2005 from a single large academic medical center (N?=?187). Dysphagia recommendations from final SLP hospital notes and from hospital (physician) discharge summaries were abstracted, coded, and compared for each patient. Recommendation categories included dietary (food and liquid), postural/compensatory techniques (e.g., chin tuck), rehabilitation (e.g., exercise), meal pacing (e.g., small bites), medication delivery (e.g., crush pills), and provider/supervision (e.g., 1-to-1 assist). Forty-five percent of discharge summaries omitted all SLP dysphagia recommendations. Forty-seven percent (88/186) of patients with SLP dietary recommendations, 82% (93/114) with postural, 100% (16/16) with rehabilitation, 90% (69/77) with meal pacing, 95% (21/22) with medication, and 79% (96/122) with provider/supervision recommendations had these recommendations completely omitted from their discharge summaries. Discharge summaries omitted all categories of SLP recommendations at notably high rates. Improved post-hospital communication strategies are needed for discharges to subacute care.     

Long-term Mortality after Acute Myocardial Infarction in Relation to Prescribed Dosages of a Beta-Blocker at Hospital Discharge

This study was designed to describe the 5-year mortality rate in relation to the dose of metoprolol prescribed at hospital discharge after hospitalisation for acute myocardial infarction (AMI). All patients discharged alive after being hospitalized for AMI at Sahlgrenska Hospital (covering half of the community of Göteborg, with 500,000 inhabitants) during 1986–1987 (period I) and all patients discharged alive after hospitalization for AMI at Sahlgrenska Hospital and östra Hospital (covering the whole area of the community of Göteborg) in 1990–1991 (period II) were included. Overall mortality was retrospectively evaluated over 5 years of follow-up. In all there were 2161 patients who were discharged after AMI. Seventy-three percent of these patients were prescribed a beta-blocker and 59% were prescribed metoprolol. Of the patients prescribed metoprolol, 34% were on 200 mg, 46% on 100 mg, and 20% on 50 mg or less. Information on 5-year mortality was available for 2142 of the 2161 patients (99.1%). The 5-year mortality was 24% among patients prescribed 200 mg, 33% among patients prescribed 100 mg, and 43% among patients prescribed 50 mg (P < 0.0001). Patients prescribed another beta-blocker had a 5-year mortality of 39%, and patients prescribed no beta-blocker at all had a 5-year mortality of 61%. When correcting for dissimilarities at baseline, patients who were prescribed 100 mg had an adjusted risk ratio for death of 0.79 (95% confidence limit 0.64–0.96; P = 0.021) as compared with patients not prescribed a beta blocker. The corresponding figure for patients prescribed >100 mg was 0.63 (95% confidence limit 0.48–0.84; P = 0.001). Both patients prescribed high and low doses of metoprolol after AMI appeared to benefit from treatment. There was a trend indicating more benefit when larger doses were prescribed.     

Diagnosis coding in The Danish National Patient Registry for respiratory syncytial virus infections

This national registry-based epidemiological study aimed to evaluate the usefulness of the Danish National Patient Registry (DNPR) as a tool for epidemiological studies of respiratory syncytial virus (RSV) hospitalizations. Information on RSV diagnoses in records of hospitalizations among inpatients tested for RSV in Denmark from January 1996 to May 2003 in the DNPR was validated against the RSV test result in records from the 18 laboratories testing for RSV among hospitalized patients in Denmark. Of 16,733 RSV-positive samples representing a total of 14,898 hospitalizations in the DNPR, 68% (10,111) had been registered in the DNPR with 1 or more RSV diagnoses. Age influenced the odds ratio (OR) of being coded with a RSV diagnosis among patients with a RSV positive test, hence 73% of infants compared to 57% of patients beyond infancy had been registered in the DNPR with 1 or more RSV diagnoses. The OR of being coded with a RSV diagnosis among patients with an RSV positive test was increased over the study period and was also increased by increasing length of hospitalization and by the presence of secondary diagnoses. The OR was decreased by the presence of asthma and other chronic conditions in the patients. The OR was furthermore influenced by RSV seasonality and by hospital. Taking into account a loss of 27% of RSV hospitalizations, DNPR can be used for epidemiological studies of RSV among infants in Denmark.     

Long-Term Reliability and Validity of Alcoholism Diagnoses and Symptoms in a Large National Telephone Interview Survey

The long-term reliability and validity of telephone lay interview assessments of alcoholism were examined in the context of a large national community-based survey of over 8,000 male Vietnam era veterans. A subsample of 146 men was interviewed twice by telephone using the same structured interview an average of 15 months apart to evaluate the long-term reliability of alcoholism symptoms and diagnoses. In addition, a search of Department of Veterans Affairs patient treatment files of inpatient hospitalizations between 1970 and 1993 yielded a subsample of 89 interviewed men with a past discharge diagnosis of alcohol dependence. The test-retest reliability of alcohol abuse and alcohol dependence diagnoses was good, with kappa coefficients of 0.74 and 0.61, respectively. The reliability of individual alcoholism symptoms was fair to good, with kappas of 0.46 to 0.67. Ninety-six percent of individuals identified by Department of Veterans Affairs patient treatment files as having an alcohol dependence diagnosis were correctly diagnosed by the telephone interview. The results of the present study provide additional evidence for the long-term reliability and validity of lifetime alcoholism diagnoses, and suggest that the reliability and validity of telephone interview assessments of alcoholism are as good as that of an in-person interview. Telephone administration of structured psychiatric interviews appears to be an attractive alternative to in-person interviewing for gathering information about alcoholism and alcohol-related problems.